Year: 2020

On June 26, 2020, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and Pricing, Data Analysis, and Coding Contractor (PDAC) released a joint announcement for a new coding verification requirement for the six lower limb prostheses that were previously announced as  subject to Medicare prior authorization. While implementation of Medicare prior authorization has been postponed due to the COVID-19 public health emergency, it is expected that the program will be implemented in the future.

The joint publication announced that, effective for claims with dates of service on or after January 1, 2021, the only products which may be billed using codes L5856, L5857, L5858, L5973, L5980, and L5987 are those for which a written Coding Verification Review has been made by the PDAC and is listed on the PDAC Product Classification List.

In addition to the joint DME MAC/PDAC publication announcing the coding verification requirement for the six prosthetic codes discussed above, the four DME MACs simultaneously released a revised version of the Lower Limb Prostheses Policy Article (PA) with an effective date of August 1, 2020.  The revised PA includes new coding guidelines for L5856, L5857, L5858, L5980, L5981 and L5987.  Coding guidelines for L5973 were published in a previous (January 2020) Policy Article revision.

AOPA’s Coding and Reimbursement Committee will be undertaking a comprehensive review of the Policy Article coding guideline revisions as well as the coding verification requirement and will engage in collaborative discussions with the PDAC and the DME MACs.

The joint publication announcing the coding verification requirement may be viewed here. And view the revised Lower Limb Prosthesis Policy Article here.

Questions may be directed to Joe McTernan at jmcternan@aopanet.org or Devon Bernard at dbernard@aopanet.org.

Even though we won’t be face-to-face, the 2020 Virtual National Assembly will have it all…

• The best in business education and advanced clinical programming offered in general sessions, poster presentations, and engaging concurrent breakouts.
•  A robust exhibit hall.
• Roundtable discussions with the most influential people in the profession.
• Fun events such as coffee breaks and live entertainment.
• The opportunity to earn a substantial amount of CE credits. Education will be available 30 days post Assembly, giving you the opportunity to go back and attend multiple concurrent sessions.
• An easy to use platform that is mobile, computer, and tablet responsive. Plus, access to training and a dedicated help desk.
• No travel required, saving you time and money.

You won’t want to miss out, register today!  

View the tentative schedule here and stay tuned for the specifics on education.

Questions? Contact info@AOPAnet.org or (571) 431-0876.

This week Congress finalized legislation to ensure that businesses that received a forgivable loan through the Paycheck Protection Program (PPP) can have more leeway on how to spend those funds.

Under the newly-passed Paycheck Protection Program Flexibility Act of 2020 small businesses would have to spend just 60 percent of the loan money on payroll instead of 75 percent as outlined in the original law. In addition, current PPP borrowers can choose to extend the eight-week period of the disbursement to 24 weeks, or they can keep the original eight-week period if their business has sufficiently recovered. New PPP borrowers will have a 24-week covered period, but the covered period can’t extend beyond December 31, 2020. Borrowers can use the 24-week period to restore their workforce levels and wages to the pre-pandemic levels required for full forgiveness. This must be done by December 31, 2020, a change from the previous deadline of June 30, 2020.

The bill includes two exceptions allowing borrowers to reach full PPP loan forgiveness even if they aren’t able to fully restore their workforce. Previous guidance already allowed borrowers to exclude from those calculations employees who turned down good faith offers to be rehired at the same hours and wages as before the pandemic. The new bill allows borrowers to adjust because they could not find qualified employees or were unable to restore business operations to February 15, 2020, levels due to COVID-19 related operating restrictions.

Finally, the bill extends a June 30, 2020 deadline to rehire workers, pushes back the timeline for repaying loans, and allows companies that get loan forgiveness to defer payroll taxes. 

The President is expected to sign the bill into law shortly. For questions, please contact Justin Beland, Director of Government Affairs at jbeland@aopanet.org, and keep checking our COVID-19 resources page for more updates.

The death of George Floyd, the protests, and the disproportionate impact COVID-19 is having on racial and ethnic minorities and the poor and socially disadvantaged among us has once again brought to the forefront the long-standing issue of systematic racism in this country.

The American Orthotic and Prosthetic Association (AOPA) stands with our members in opposing systemic racism and believes it is time to meaningfully address the impacts it has on our society. Until we do, a large percentage of the patients AOPA members serve, those living with limb loss/difference and limb impairment in disadvantaged communities, will never be truly healthy.

Now more than ever, it is imperative to reflect on the values of the orthotics and prosthetics profession and its patients, to remember character is not only what we believe but what we do. As Martin Luther King, Jr. observed, “The ultimate tragedy is not the oppression and cruelty by the bad people but the silence over that by the good people.”

Today, we reaffirm our values, beliefs, and commitments. We cannot solve these problems alone, but AOPA is committed to the principles of diversity, equality, and inclusion with each other, our allied healthcare professionals, and in all patient interactions. AOPA is committed to health equity and to improving the health outcomes of our patient populations. AOPA stands united, ready to learn, grow, and work toward a better future.

About the American Orthotic and Prosthetic Association (AOPA): Through advocacy, research, and education, AOPA improves patient access to quality orthotic and prosthetic care. AOPA, based in Alexandria, VA, is the largest non-profit organization consisting of more than 2,000 O&P patient care facilities and suppliers, dedicated to helping O&P businesses and professionals navigate the multitude of issues surrounding the delivery of quality patient care.

We hope this note finds you and your loved ones safe and well. We are reaching out today with an announcement about the 2020 National Assembly. Due to the ongoing COVID-19 pandemic, the American Orthotic and Prosthetic Association (AOPA) has decided that the in-person 2020 National Assembly that was scheduled to take place September 9-12 at Mandalay Bay Resort & Casino in Las Vegas has will instead be delivered virtually on the same dates.

This was not an easy decision, but ultimately the health and safety of our attendees, exhibitors, speakers, and staff were our top priority.

AOPA is very excited about the opportunities that a Virtual National Assembly offers, rest assured that it will be full of the same great content and networking opportunities that were planned had we been face-to-face. AOPA intends to channel the energy expended thus far by the Planning Committee into a remote learning and engaging event with continuing education credits for the highest level of O&P clinical, business, and technical education. AOPA stands committed to serving its members and the extended O&P community by providing access to quality education while saving costs – dollars on travel, lodging, and entertainment.  

In the coming weeks, we will be reaching out with specific communication to exhibitors, speakers, and attendees to share relevant information.

Thank you for your support during these unprecedented times. As we prepare for the first-ever Virtual National Assembly, we hope you and your loved ones remain safe and well. We look forward to seeing you online in September.

If you have questions please contact Tina Carlson at tcarlson@aopanet.org

The COVID-19 pandemic has led to an increasing reliance on telehealth and other virtual forms of patient interaction. However, under the current billing structure, orthotists and prosthetists are unable to submit claims for certain Medicare services despite being considered essential providers. Key members of Congress are currently circulating a letter to be sent to Secretary of Health and Human Services Alex Azar and Administrator of the Centers for Medicare and Medicaid Services Seema Verma urging them to reconsider this policy during the COVID-19 Public Health Emergency (PHE). We urge you to write your legislators and ask them to sign on to this letter.

During the pandemic, orthotists and prosthetists have relied on telehealth as a valuable mechanism for providing care to patients to address issues such as skin breakdowns, ensuring safe use of the prosthesis and/or orthosis, and assisting beneficiaries with adjustments to their wearing schedules. While our profession is able to provide a wide range of direct clinical care via telehealth there is currently no reimbursement for non-repair services provided to these patients after 90 days from the date of delivery. The congressional letter seeks a temporary solution to this issue.  

We’d love to have your legislators join this letter – please visit our AOPA Votes page to get started. The process will take just a few minutes but can make a big difference. Thank you for your advocacy efforts!

Questions? Contact AOPA’s Director of Government Affairs Justin Beland at jbeland@AOPAnet.org.  

AOPA staff recently participated in educational webinars presented by the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and on DME MAC provider advisory councils during which they  confirmed that physicians, including MDs and DOs that are certifying the medical need for diabetic shoes may utilize telehealth to fulfill face-to-face encounter requirements during the COVID-19 Public Health Emergency (PHE). 

On April 6, 2020 the Centers for Medicare and Medicaid Services (CMS) released an Interim Final Rule with Comment Period (IFC) that indicated for claims with dates of service on or after March 1, 2020, policy based “requirements for face-to-face or in-person encounter for evaluations, assessments, certifications or other implied face-to-face services would not apply during the COVID-19 PHE.”

Additional guidance was provided on the IFC by the DME MACs on May 7, 2020 in a joint educational article.  The DME MAC article indicated that while the IFC provided significant relief from policy-based face-to-face visit requirements, a subsequent CMS IFC that was issued on May 8, 2020 reiterated the statutory requirement to establish and document the medical necessity for Medicare covered services.  The DME MAC article indicated that Medicare approved, physician-based telehealth visits, including those that meet the relaxed telehealth rules in effect during the COVID-19 PHE, will be considered compliant for purposes of establishing and documenting the medical necessity of Medicare covered services.  Telehealth based physician encounters will also meet any face-to-face visit requirements that are incorporated into existing Medicare policies. 

The DME MAC joint article indicated that the IFC based waiver of face-to-face encounter requirements only applies to policy-based requirements and therefore does not apply to face-to-face encounter requirements that are memorialized elsewhere, specifically those that are part of the DMEPOS Quality Standards or Social Security Act.  This led to significant questions, especially related to Medicare coverage of therapeutic shoes which require in-person visits with the certifying physician and the supplier of the shoes.  While the IFC allows certifying physicians to use telehealth encounters to certify the medical necessity of diabetic shoes, suppliers of diabetic shoes, including orthotists, prosthetists, and pedorthists will still be required to perform an in-person evaluation at the time of shoe selection and an in-person fitting of the shoes at delivery as these are addressed in Appendix C of the DMEPOS Quality Standards.

Access the DME MAC guidance article on the CMS IFC.

Questions regarding this issue may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.

For more on telehealth join AOPA next Tuesday, May 19 from 3:30 to 4:45pm ET as we will hold our second Townhall, Operating During the Pandemic: Telehealth and Continuum of Care.

As part of the CARES Act, Congress established a Provider Relief Fund, with $50 billion allocated to Medicare facilities and providers impacted by COVID-19 and based on eligible providers’ 2018 net patient revenue. Many AOPA member received funding when the initial $30 billion was distributed between April 10 and 17. Late last week, the Department of Health and Human Services (HHS) released information on the remaining $20 billion, presenting an opportunity for additional funding.

The remaining $20 billion will be distributed in two ways – an automatic distribution to Medicare providers who previously submitted cost reports, and subsequent waves of distributions based on Medicare providers’ applications in a General Distribution Portal. HHS’ goal is to augment providers’ allocations so that all funding is proportionate to each provider’s share of 2018 net patient revenue. For example, certain providers (such as children’s hospitals) have a small Medicare proportion and were allocated a small amount from the initial $30 billion Distribution, and therefore are eligible to receive more from the $20 billion Distribution. HHS has stated that the General Distribution will ideally replace a percentage of providers’ annual gross receipts, sales, or program services revenue during this period.

Medicare providers who have already received a payment from the Provider Relief Fund are eligible to apply for additional funds by submitting data about their annual revenues and estimated COVID-related losses via a General Distribution Portal. While providers received the initial funds automatically, in this second disbursement, HHS will require providers to submit their revenue information through the General Distribution Portal, so the cost report data can be verified. HHS has noted that any provider who received a payment from the Provider Relief Fund as of 5pm ET Friday, April 24 can and should apply for additional funding via the Provider Relief Fund Application Portal.

More information on the application process (including all information needed for the application) can be found in an FAQ and user guide created by HHS.

HHS will be processing applications submitted through the General Distribution Portal in batches every Wednesday at noon ET. The funds will not be distributed on a first-come-first-served basis; therefore, applicants will be given equal consideration regardless of when they apply before each processing deadline and will not be penalized for taking several days to collect the required information. HHS plans to issue payments on a weekly, rolling basis, as information is validated, estimating the first payments will go out 10 business days after the first submission deadline. That said, the intent is to disburse the funds quickly.

As reported yesterday by AOPA, as of April 26 the Centers for Medicare & Medicaid Services (CMS) ended its Medicare Accelerated and Advanced Payment Program because of the additional Provider Relief funding.  Those who were expecting advanced payments should consider applying for this additional funding.

If you are looking for a deeper dive into O&P policy issues including COVID-related legislation join us Wednesday, May 6 from 1 to 3pm ET for  the 2020 Virtual Policy Forum.

For any questions on the HHS disbursements or the Policy Forum, please contact Justin Beland, AOPA’s Director of Government Affairs at jbeland@AOPAnet.org.

Yesterday, April 26, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that it is re-evaluating payments made to Medicare Part A providers through the recently expanded Accelerated Payment Program and suspending the Advance Payment Program for Medicare Part B providers effective immediately.

The Medicare Accelerated and Advance Payment Program (AAP) is a longstanding program that authorizes Medicare contractors to make up to three months of expected Medicare payments to Part A providers (accelerated payments) and Part B providers (advance payments) during a public health emergency that results in the disruption of claim submission or claim processing. In early April, CMS announced it was expanding the AAP program to include Medicare Part A and Part B providers impacted by the COVID-19 Public Health Emergency, allowing them to receive accelerated and advance payments from Medicare as a means to temporarily maintain adequate cashflow to support their businesses.

The April 26 announcement indicates that due to Medicare accelerated and advance payments of approximately $100 billion to providers through the AAP program to date, and the $175 billion of appropriated grant funds through COVID-19 related provider relief legislation, CMS is reevaluating the AAP program and is reviewing all new and pending applications for Medicare Part A accelerated payments and suspending the Medicare Part B advance program outright, no longer accepting new applications for advance payments from Part B providers.

The CMS announcement may be reviewed here. AOPA is reviewing the CMS announcement including its potential impact on AOPA members and will provide CMS with appropriate comments.

Questions regarding this may be directed to Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.